infertility and IVF

Question 1

basic investigations for infertility

Answer 1

semen analysis
serum progesterone 7 days prior to expected next period

Question 2

interpretation of serum progestogen

Answer 2

< 16 nmol/l: repeat if consistently low refer
16-30: repeat
> 30: indicates ovulation

Question 3

key counselling points for infertility

Answer 3

folic acid
aim for BMI 20-25
advise sex every 2-3 days
smoking/drinking advice

Question 4

classes of anovulation

Answer 4

class 1: hypogonadotropic hypogonadal anovulation- hypothalamic amenorrhoea
class 2: normogonadotropic normoestrogenic anovulation- PCOS
class 3: hypergonadotropic hypoestrogenic anovulation- premature ovarian insufficiency

Question 5

management for ovulation induction

Answer 5

exercise and weight loss (first line patients with PCOS)
Letrozole (first line medical in PCOS)
clomiphene citrate
gonadotropin therapy (for class 1)

Question 6

side effects of ovulation induction

Answer 6

ovarian hyperstimulation syndrome

Question 7

what is ovarian hyperstimulation syndrome

Answer 7

ovarian enlargement with multiple cystic spaces form can cause hypovolaemic shock, acute renal failure, VTE or arterial thromboembolism

Question 8

management of ovarian hyperstimulation syndrome

Answer 8

fluid and electrolyte replacement
anti-coagulation therapy
abdominal ascitic paracentesis
pregnancy termination